PROFESSIONAL SOFTWARE PRACTICE

Professional Software Practice



Professional Software Practice

Introduction

It seems that we are at a turning point with respect to assessment of medical IT-based solutions in more than one sense. Firstly, the issues of concern slowly tend to include soft human issues. Secondly, assessments tend to become constructive rather than only summarising. Moreover, thirdly, a large number of scientific papers and reviews appear on the topic, but still only few contain a full-fledged methodology, of which most originate from assessment of knowledge-based systems (KBS). All of these issues are discussed in this review paper to make the step from trends in today's practice to recommendations for the future practice(Gupta, 1993, pp. 343).

Trends in assessment of medical IT-based solutions

Technology assessment (TA) is generally perceived as an assessment prior to decision making and an application/diffusion of a technology as defined in : 'a science-based policy instrument which attempts to bridge the gap between the technological potential and the social and economic needs and wishes'. TA is concerned with the assessment of 'safety, efficacy, feasibility, and indications for use, cost, and cost-effectiveness of a particular technology—including social, economic, and ethical consequences—to improve health care decisions' (citing the American Institute of Medicine 1983, Office of Technology Assessment), see also 3 and 4. This indicates explicitly that the validity of any technology is not only concerned with fulfilment of specifications of functions, but includes the interaction of the technical system with its organisational environment. It also indicates, that there is a prospective element (cf 'feasibility') as well as a retrospective element. Particularly for the IT-based technology, TA is evolving to include not only 'go/no go' decisions for buying but also the entire development of such technologies 3, 5 and 6. This again—slowly—leads to a suggestion for formative2 or constructive technology assessment, at which the user is actively involved to guide the development process in a desired direction 5, 8 and 9. Constructive assessment is a strategy deployed by the project management, which means that assessment activities are used actively and consciously as a means for the decision making on directions and corrections to apply during the development of an IT-application. Still, few cases of prospective TA have been accomplished and less with constructive TA , even today. The shift in interpretation from summative to constructive assessment implies a shift in target users from central medical decision and policy makers at the diffusion of the technology—as is the feeling from several papers in —to an involvement of members of the end-user organisation . (Laopodis, 1994, pp. 235)

Recently, concerns like user satisfaction and usability (ergonomic assessment) have gained attention. For instance, the concept of 'usability laboratories' are becoming increasingly popular at the big software/ system vendors. Ergonomic assessment is concerned with the users' practical and mental workload when physically operating the IT-system. It is concerned with e.g.: (1) the number of key-strokes necessary to complete a particular action; (2) how much memorised information is needed to perform an operation or to retrieve information; or (3) how difficult it is ...